- December 3, 2024
- Posted by: Josh Knoll
- Category: Prior Authorization
You have probably heard the adage, “Old habits die hard”. Benjamin Franklin penned it, and Mick Jagger crooned it.
And every day you live it as you continue to manage prior authorization on your own.
With the changing administrative protocols and increasing complexities within the healthcare industry, continuing this habit might result in adverse scenarios.
In fact, the AMA survey 2023 [1] has already explained the doomed condition of physicians, other healthcare professionals and facilities considering the burdensome authorization process.
On the other hand, the circumstances also resulted in delayed patient care and poor health outcomes of the patients simultaneously.
Revamping your prior authorization process is a crucial decision. Everything must fall into place to obtain accurate and timely reimbursements while sustaining the quality of care you provide.
However, it is essential that you find the exact time and strategy to optimize your preauthorization process.
Let’s start with that!
Do You Have a Crooked Prior Authorization Process?
There are numerous signs that suggest the need for a new approach or strategy in your practice management. While some are clear-cut, others might be less obvious. Here we have discussed three signs that you should notice to protect and improve your organization’s financial outcomes and patient satisfaction rankings.
1. Physician and staff burnout
Let’s face it; no one chooses a career in healthcare for paperwork. It’s the patients that inspire you.
But prior authorization leads to substantial administrative burden leading healthcare professionals towards burnout. In fact, the AMA survey has identified that 95% [1] of 1000 physicians have reported that authorization is a major reason for physician burnout and stress.
In regular day-to-day operations it’s the little things that wear you down:
- Duplicate data entry, where the same information is typed over and over through different fields of a form.
- Waiting on the line to get questions to do with prior authorization procedures or status of submissions answered.
- Informing patients that you cannot provide a treatment without the consent of the payer.
The healthcare industry is already amidst staffing shortage considering people leaving the industry, increasing aging population and competition within the industry remains high.
On top of that, the increasing complexities within the prior authorization process make it difficult for the providers to balance patient and administrative care.
2. Denial reworks
Do you know that 90 percent of denials can be avoided altogether?
The prior authorizations today act as a nightmare with much repetitive data entry (typos are common right here).
Further, a patient with poorly coded diagnosis, or failure of clinical documentation or where the code used is incorrect ceases prior authorization requests.
Also, every refusal of prior authorization shall be redesigned. Worse still, the audits result in only two-thirds of preventable denials being successfully appealed meaning you can never recoup the revenue you lost.
Moreover, you are not positioning yourself to avoid prior authentications denial initially and, therefore, the consequent rise in expenses due to carry out. Not to mention the fact that your patients receive unnecessary care delays.
3. Treatment delays and care abandonment
94% of the physicians admitted that due to prior authorization there are care delays, and 78% said there are incidence of treatment abandonment due to this frustrating process in the care process.
Not only is that bad for your patients and rather unproductive and frustrating for you, but it is worse for your pockets, too.
For instance, it does not allow you to reach patients in the first instance. Take physical therapy. You require continuity of care in order to gain patients’ cooperation on the therapy.
However, if you hope for the first appointment, additional treatments may be stalled or go uncompensated. This is demoralizing to the patients and is a waste of your money.
Delay in treatment introduction is inevitable, and it creates unpredictability of your revenue cycle.
Prior Authorization Burden Remains, Sun Knowledge Can Help
We as the best prior authorization company supply numerous services managing all your billing issues with clients nationwide. Our team of professionals is here to assist healthcare providers to complete the often-confusing prior authorization process so that they can provide the best patient care possible.
When you choose to work with us for your prior authorization requirements, you will be able to harness our experience in…
- streamlining workflows
- reducing operational cost
- achieving an optimal result of the reimbursement
Our mission is to deliver value by offering affordable, high-quality services to serve the needs of healthcare organizations in over 30 specialties.
So, what are you waiting for? Outsource your prior authorization services to Sun knowledge Inc. Try our professional services and let us help you maximize your practice while keeping you in line with the laid down regulations.
Ref Link:
[1] https://www.ama-assn.org/system/files/prior-authorization-survey.pdf